Microsurgery
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The effect of hyperbaric oxygen (HBO) on ischemia-reperfusion injury of skeletal muscle, applied during different periods, was studied in 56 male rats. Animals were subjected to 6-h ischemia by a tourniquet over the major femoral trocanter and 4 (A) or 24 (B) h of reperfusion. HBO was carried out during 1 h in an acrylic chamber at a pressure of 2.0 ATA (100% oxygen): in the last 60 min of ischemia (II), after ischemia, during 1-h reperfusion time (III), and during the last hour of ischemia plus 1-h reperfusion (IV). ⋯ No interstitial hemorrhage, neutrophil infiltrate, or cellular necrosis were induced by HBO. The apoptosis index did not differ among the groups. HBO reduced morphologic alterations and promoted better results when administered in the ischemia plus reperfusion period (GIV).
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The aim of this follow-up study was to evaluate the functional and subjective results after thumb replantation. Twenty-four patients with replantation of the thumb, performed during the period 1992-1997, were reexamined after 6.5 years (range, 4.2-9.1 years post-injury). In 10 cases the amputations were isolated, 14 amputations were combined with other injuries of the hand, 15 amputations resulted from crush/avulsion injuries, and 9 amputations were sharp. ⋯ Functional results were independent of amputation levels and patient age. Although the results of cutaneous sensibility were only moderate, patients were able to use their thumb to perform work and daily living activities. The majority of patients had returned to their previous occupation.
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Case Reports
Limb salvage of infected diabetic foot ulcers with free deep inferior epigastric perforator flaps.
Soft-tissue reconstruction of the feet in diabetic patients with angiopathy, sensorial neuropathy, and immunopathy is a complicated problem. Until the mid-1980s, chronic foot ulcers in diabetic patients were treated conservatively, because flap surgery was regarded as too risky. However, in recent years, early debridement and flap coverage have become popular reconstructive methods for diabetic foot wounds. ⋯ It provides a large amount of skin and subcutaneous tissue, without the donor-site morbidity of the ordinary TRAM flap. Furthermore, using the DIEP flap avoids the loss of major vessels. In this study, we report on the successful use of the DIEP flap in four cases of diabetic foot ulceration.
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Review Case Reports
Concepts of nerve regeneration and repair applied to brachial plexus reconstruction.
Brachial plexus injury is a serious condition that usually affects young adults. Progress in brachial plexus repair is intimately related to peripheral nerve surgery, and depends on clinical and experimental studies. We review the rat brachial plexus as an experimental model, together with its behavioral evaluation. ⋯ Surgical planning in root rupture or avulsion is proposed. In total avulsion, the authors are in favor of the reconstruction of thoraco-brachial and abdomino-antebrachial grasping, and on the transfer of the brachialis muscle to the wrist extensors if it is reinnervated. Surgical treatment of painful conditions and new drugs are also discussed.